Week 1-2 Flashcards
A surgical suture, also known as a stitch or stitches, is a _______ used to __________ and ____________ after an injury or surgery.
medical device
hold body tissues together
approximate wound edges
There are numerous types of suture which differ by _______ and _______ as well as __________ and characteristics
needle shape and size
thread material
_________ , or _______, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread.
Swaged
atraumatic
The _____ and ______ needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.
ski and canoe
Monofilament versus polyfilament threads
Monofilament fibers have less _________ but create less _________ and are more appropriate with ______ tissues where ___________ can be more significant such as _________________.
tensile strength ; tissue trauma
delicate tissues ; tissue trauma
small blood vessels.
Monofilament versus polyfilament threads
Polyfilament (_________) sutures are composed of multiple fibers and are generally greater in _______ with greater ___________, however, they tend to have greater ____________ and theoretically have more propensity to harbor _________
braided; diameter
tensile strength; tissue reaction
bacteria
Other properties to consider between a mono or poly filamentous thread
Tensile strength: the ability of the suture to _____________________.
Elasticity: the ability of the suture material to ______________ such as in cases of ________.
Tissue reactivity: ______________ of the surrounding tissue that can cause materials to break down quicker and lose tensile strength.
Knot security: the ability of the suture to __________________
hold tissues in place without breaking
adapt to changing tissues ; edema
inflammatory response
maintain a knot that holds the thread in place
(Absorbable or Non absorbable?) (natural or synthetic?) suture have the (Absorbable or Non absorbable?) (natural or synthetic?) fibers have the highest rates of tissue reactivity.
Non absorbable synthetic
absorbable natural
Absorbable sutures are either degraded via ___________ or ___________ and should not be utilized on body tissue that would require greater than ___________ of tensile strength.
proteolysis : hydrolysis
two months
Absorbable sutures are generally used (internally or externally?) during surgery or to avoid further procedures for individuals with (low or high?) likelihood of returning for suture removal.
Internally ;low
Natural absorbable
Natural absorbable material includes ___________ , ___________ and ___________ which are all produced from the _____ extracted from ____________.
They are all (mono or poly?) filaments which have different degradations times ranging from ___-____days.
plain catgut, chromic catgut and fast catgut
collagen; bovine intestines
poly; 3–28
Synthetic absorbable
Synthetic absorbable material includes ________ acid, ________ acid, _________, Polydioxanone and Polytrimethylene carbonate.
Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation
Polyglactic
Polyglycolic
Poliglecaprone
Best used on:
Plain catgut-
Chromic catgut
Fast catgut-
Mucosal tissues
Mucosal, skin, genitalia
Mainly skin, also mucosal
Non-absorbable
They are appropriate for tissues with a (low or high?) degree of mechanical or shear force (________, certain skin location).
High
tendons
Sutures
Natural non-absorbable : ______
Synthetic non-absorbable: ______,______,_________
Silk
nylon, polypropylene and surgical steel
Sutures
Natural non-absorbable : Silk - ____filament
Synthetic: includes nylon, polypropylene and surgical steel all of which are _____filaments
poly
mono
A Marjolin ulcer is a ___________ that arises in the setting of ____________ skin, _______ scars, and _______ wounds
cutaneous malignancy
previously injured
longstanding
chronic
_____________________ (ERAS) is a modern approach to help people _______ following surgery
Enhanced Recovery After Surgery
recover quicker
ERAS PROTOCOL
Pre-Operative
•Ensuring the patient is as healthy as possible prior to surgery, through ______ and ________
•Optimising medical management, including _________ and ________
•__________ prior to surgery to enhance bowel recovery and avoid bowel prep if appropriate
•Solids allowed until _______ pre-operatively (unless contra-indicated)
•Intake of clear fluids until ______ prior to surgery, with some centres moving towards being able to drink clear fluids up to the time of leaving the ward
•Loading with 12.5% _________ within 2 hours of surgery
exercise and weight loss
smoking and alcohol cessation
Altered diet; 6 hours
2 hours
carbohydrate beverage
ERAS PROTOCOL
Intra-Operative
•Use of multimodal and _______ analgesia, including regional anaesthesia*
•Includes avoidance of ____-acting benzodiazepines in the elderly
•Use of multimodal postoperative __________________ prophylaxis
•Use of _______________ surgery
•Targeting a goal-directed fluid therapy regime, including goal-directed _______ management
opioid-sparing
short; nausea and vomiting
minimally invasive
haemostasis
Regional anaesthesia includes _______ and ________ anaesthesia, __________ catheters, and _____________ regional blocks
spinal and epidural anaesthesia
rectus sheath catheters
local anaesthetic regional blocks
ERAS PROTOCOL
Post-Operative
Ensure adequate _________ is achieved to allow for early mobilisation
Early ________ and optimising nutrition
Multi-disciplinary post-operative patient follow-up, including in the post-acute care phase
pain control
oral intake
There are several parts to the operating theatre:
List them
Scrubbing area
Operating room
Anaesthetic room
Storage area
There are several parts to the operating theatre:
_____________ – contains sinks and sterile gowns, gloves, and masks/visors etc
___________ – contains the scrub nurse table
Scrubbing area
Operating room
Storage area also are often sterile
T/F
T
The time it takes for a tissue to no longer require support from sutures will vary depending on tissue type:
Days: ____,_______, or ______
Weeks to Months: ________ or ______
Months to Never: ______________
Muscle, subcutaneous tissue or skin
Fascia or tendon
Vascular prosthesis
The ideal suture is the (smallest or largest ?) possible to produce uniform tensile strength, securely hold the wound for the required time for healing, then _________. It should be predictable, easy to handle, produce minimal reaction, and knot securely.
Smallest
be absorbed
_________ sutures are commonly used for deep tissues and tissues that heal rapidly
Absorbable
For the more commonly used absorbable sutures, complete absorption times will vary:
Vicryl rapide =___ days
Vicryl = ___ days
Monocryl = ~____ days
PDS = ~_____ days
42
60
100
200
Non-Absorbable Sutures
Non-absorbable sutures are used to provide _____-term tissue support, remaining ______ by the body’s ________ (until removed manually if required).
long
walled-off
inflammatory processes
Non-absorbable sutures
Uses include for tissues that heal (rapidly or slowly?) , such as ______ or ______ , closure of __________, or _______ anastomoses.
slowly
fascia or tendons
abdominal wall
vascular
Monofilament vs Multifilament
Suture materials can also be sub-classified by their structure:
Monofilament suture – a single stranded filament suture (e.g _____,——- *, or prolene).
Multifilament suture – made of several filaments that are twisted together (e.g _______ or _______ ).
nylon; PDS
braided silk or vicryl
Monofilament vs Multifilament sutures
Monofilament suture
-(Lower or Higher?) infection risk
-(good or poor?) knot security and ease of handling.
Multifilament suture
-(good or poor?) knot security and ease of handling
-(Lower or Higher?) infection risk
Lower; poor
Good; Higher
The larger the size ascribed to the suture, the _______ the diameter is, for example a 7-0 suture is ______ than a 4-0 suture.
smaller
smaller
When choosing suture size, the _______ size possible should be chosen, taking into account the _______ of the tissue.
smallest
natural strength
Commonly, surgical needles are made from _____________ .
stainless steel